Introduction to Immediate Post-Operative Prosthesis (IPOP)
Amputation is a critical salvage procedure when it comes to septic and tumour patients. Due to the process of ‘coning’ of the residual limb, which is undertaken in order to facilitate the application of a primary prosthesis, the rehabilitation process post-surgery is often delayed; which can be extremely costly both to the patient as well as the health system.
It is also during this time that muscle strength, tone, general fitness and co-ordination may be reduced, which further retards the rehabilitative process.
The Immediate Post-Operative Prosthesis (IPOP) technique attempts to address these problems with the application of a rigid cast immediately post-surgery while the patient is still in the operating theatre, and the attachment of a temporary prosthesis soon thereafter. This ensures that the healing of the wound and the rehabilitation process occur in tandem, thereby diminishing the effects of muscle wasting and enabling more rapid mobilisation with the primary prosthesis.
The Immediate Post-Operative Prosthesis (IPOP) technique dates back to 1893
The Immediate Post-Operative Prosthesis (IPOP) technique is not new. In fact, the first reports of the use of the IPOP technique date back to 1893, when a German surgeon, von Bier, reported accelerated rehabilitation with the use of a rigid plaster cast to which a wooden peg leg was attached immediately following surgery.
In 1918, a surgeon by the name of Wilson also reported excellent results having used the IPOP technique on injured soldiers during World War I.
In 1957, surgeons Berlemont and Wiess reported the successful use of a thigh cast attached immediately post-surgery to below knee prostheses following trans tibial amputations.
In South Africa, the IPOP technique has been used for several decades. However, such usage has not been well-documented, and this appears to be the reason behind the fact that the technique has been under-utilised in recent years.
Recently, a prospective study of septic and tumour amputees was undertaken at the Johannesburg Hospital in order to evaluate the advantages and disadvantages of the IPOP technique.
The Immediate Post-Operative Prosthesis (IPOP) technique: six-step process
What follows is a brief six-step process outlining the technique involved in creating an ‘Immediate Post-Operative Prosthesis’ otherwise known as ‘IPOP’:
The surgeon first performs the surgical procedure and isolates the sterile wound.
Orthopedic wool is then wrapped around the residual limb (stump), following which, a crêpe bandage as well as Elastoplast bandages are also applied.
Further padding and a stockinette is applied at this stage.
A layer of plaster bandage is then applied to ensure a smooth rigid cast with no sharp edges.
Fiberglass bandages are then applied.
A peg leg should be attached within two days post-surgery which enables the patient to walk within two to five days thereafter.
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Benefits of the Immediate Post-Operative (IPOP) technique
The IPOP technique aids in the prevention of swelling that would otherwise need to be reduced using coning bandages which is an extremely time consuming process, and often can take up to six months.
The rigid cast is applied in a sterile theatre which significantly reduces the chances of infection.
Results in increased psychological well-being post-surgery, in that the patient can mobilize almost immediately thereafter.
Should the patient be contracted with Roger Wolfson and Associates, an Immediate Post-Operative Prosthesis (IPOP) is offered free of charge. However, costs will be incurred should the patient already be in consultation with another prosthetist.
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